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Gallbladder

Synonym: Vesica biliaris, Vesica fellea, cholecyst, gall bladder
German: Gallenblase

1 Definition

The gallbladder serves as a storage organ for up to 30-80 ml of bile. With the withdrawal of water, the bile becomes concentrated and therefore more can be stored.

2 Anatomy

The gallbladder is pear-shaped and is located at the base of the liver in the fossa vesicae felleae. It is connected to the liver by the facies visceralis with firm connective tissue (part of Glisson's capsule). The side facing the intestines is covered by the peritoneum. It is approximately 8 cm long and 4-5 cm wide. It is divided into

  • The fundus vesicae biliaris (gallbladder fundus)
  • The corpus vesicae biliaris (body of gallbladder)
  • The collum vesicae biliaris (neck of gallbladder)

In the neck of the gallbladder and in the ductus cysticus there is a spiral mucosal fold, the plica spiralis (Heister valve), which serves as a closing mechanism and prevents bile from draining away.

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2.1 Vascular supply

The gallbladder is supplied arterially by the Arteria cystica. These originate from the Ramus dexter of the Arteria hepatica propria. The veins of the same name open into the ligamentum hepatoduodenale in the portal vein.

2.2 Innervation

The bile ducts and the gallbladder are vegetatively innervated by the plexus hepaticus, which is fed by the celiac plexus. The hormonally induced contractions of the gallbladder musculature and the slackening of the closure mechanism are strengthened by the autonomic stimulation of the gallbladder and the biliary tract. The plexus hepaticus also contains afferent pain fibres. In addition, further pain fibres travel from the peritoneum via the gallbladder into the right nervus phrenicus from the cervical plexus. This is the reason why pain in the gallbladder region can also project to the right shoulder (dermatome C4).

2.3 Palpation

An enlarged gallbladder can be palpated. It can be found below the edge of the liver, medial to the clavicular line and, dependent on breathing, emerges beneath the right costal arch.

Clinical signs on palpation are Murphy's signs and Courvoisier's signs.

3 Histology

  • The gallbladder wall consists of the tunica mucosa, which contains single-layered highly prismatic epithelium with numerous microvillii. The epithelial cells produce a glycoprotein-rich mucous, which protects the tunica mucosa from bile. The increasing number of folds in the mucous membrane, which are sporadic up until reaching the tunica muscularis, are characteristic, and depending on the state of expansion, vary in their appearance (Rokitansky-Aschoff sinuses). Often, so-called mucous bridges can be detected.
  • Lamina muscularis mucosae and tela submucosa are absent.
  • The tunica muscularis consists of grid-like connecting braided muscle cells.
  • The lamina subserosa connective tissue creates a fluid bridge to the capsula fibrosa (Glisson's capsule) in the liver.
  • The tunica serosa covers the areas, which are not united with the liver.

4 Physiology

Bile, which is formed in the liver, passes through the ductus hepaticus communis and the ductus choledochus to the duodenum. If the entrance site is closed by the musculus sphincter ampullae hepatopancreaticae, bile cannot flow into the intestines and is directed via the ductus cysticus into the gallbladder and stored here. The gallbladder is emptied by contraction of the wall muscles. Contraction is stimulated by the hormone cholecystokinin-pancreozymin (CKK), which is produced by endocrine cells in the intestinal wall and by acetylcholine from parasympathetic fibres of the vagus nerve.

5 Pathophysiology

The most frequent disease of the gallbladder is gall stones (cholelithiasis). It occurs due to a disturbance in cholesterol metabolism and occurs in approx. 15 % of adults. Gall stones can cause bilious attacks.

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